Rosner Elizabeth A, Strezlecki Kenneth D, Clark Jeff A, Lieh-Lai Mary
1Department of Pediatrics, Wayne State University, Division of Critical Care Medicine, Children's Hospital of Michigan, Detroit, MI. 2Medical Accreditation, Accreditation Council for Graduate Medical Education, Detroit, MI. 3Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
Pediatr Crit Care Med. 2015 Feb;16(2):114-8. doi: 10.1097/PCC.0000000000000302.
Thiamine deficiency has been documented in adults with diabetes and in a single report of reversible encephalopathy in a child with diabetic ketoacidosis. In children who present with severe diabetic ketoacidosis, one of the most serious complications is cerebral edema of which the primary symptom may be encephalopathy. Thiamine deficiency in other disease states has been clearly linked with acute encephalopathy, but there are no data on thiamine status in children with diabetic ketoacidosis. This study describes the prevalence of thiamine deficiency in children with type 1 diabetes mellitus who present with diabetic ketoacidosis and are admitted to the ICU.
A prospective observational pilot study.
PICU in a tertiary care children's hospital.
Children 2-18 years admitted to the ICU for treatment of diabetic ketoacidosis.
Treatment of diabetic ketoacidosis.
Twenty-two patients were enrolled. The mean age was 13.7 ± 3.6 years. Five of 21 patients (23.8%) had thiamine deficiency prior to insulin administration. After 8 hours of insulin therapy, seven of 20 patients (35%) had thiamine deficiency, and four of these seven patients also had thiamine deficiency at presentation. Sixty-eight percent of patients had a decrease in thiamine levels after 8 hours of insulin therapy, with a mean fall of 20 ± 31.4 nmol/L.
Thiamine deficiency is common in children with diabetic ketoacidosis, and this deficiency may be worsened by treatment. When metabolic acidosis persists despite appropriate treatment of diabetic ketoacidosis, other factors such as thiamine deficiency should be considered.
已有文献记载成人糖尿病患者存在硫胺素缺乏，并且有一份关于糖尿病酮症酸中毒患儿可逆性脑病的报告。在患有严重糖尿病酮症酸中毒的儿童中，最严重的并发症之一是脑水肿，其主要症状可能是脑病。其他疾病状态下的硫胺素缺乏已明确与急性脑病相关，但尚无关于糖尿病酮症酸中毒患儿硫胺素状态的数据。本研究描述了患有糖尿病酮症酸中毒并入住重症监护病房（ICU）的1型糖尿病患儿硫胺素缺乏的患病率。
一项前瞻性观察性试点研究。
一家三级护理儿童医院的儿科重症监护病房。
因糖尿病酮症酸中毒入住ICU接受治疗的2至18岁儿童。
糖尿病酮症酸中毒的治疗。
纳入22例患者。平均年龄为13.7±3.6岁。21例患者中有5例（23.8%）在给予胰岛素前存在硫胺素缺乏。胰岛素治疗8小时后，20例患者中有7例（35%）存在硫胺素缺乏，这7例患者中有4例在入院时也存在硫胺素缺乏。68%的患者在胰岛素治疗8小时后硫胺素水平下降，平均下降20±31.4 nmol/L。
硫胺素缺乏在糖尿病酮症酸中毒患儿中很常见，并且这种缺乏可能因治疗而加重。当糖尿病酮症酸中毒经过适当治疗后代谢性酸中毒仍持续存在时，应考虑其他因素，如硫胺素缺乏。
